ONE NEUROLOGIST'S OPINION REGARDING STROKE TREATMENT AND PREVENTION

Entries from March 2006

Tissue plasminogen activator (TPA) is a medication which is used to break up blood clots during an acute stroke. A recent study finds that use of TPA in patients who were over 80 years of age did not lead to an excess of brain hemorrhages.

Summary:

(As reported in the December 2005 issue of Clinical Neurology News)

TPA (Tissue Plasminogen Activator) is used within hours of an acute ischemic stroke to break up the causative blood clot. Unfortunately TPA can have the adverse effect of causing excessive bleeding, both systemically (at various sites in the body including the gastrointestinal tract) and in the brain itself. There has been some hesitancy, on the part of physicians, to treat the elderly using TPA for fear that they are much more susceptible to this complication. Dr. Demaerschalk et al. decided to see if this concern was justified. Among 69 patients who received IV TPA at the Mayo Clinic in Scottsdale, Arizona, 21 were 80 years of age or older. Analysis of the data for older patients revealed that they tended to have more severe strokes at initial presentation, having a stroke scale (NIHSS) on average of 16, compared with the moderately better result of 14 for the younger group. After receiving TPA, about 50% of patients in the older group had a 4-point or greater improvement in their stroke scale. The same degree of improvement was seen in the younger group.

In terms of life-threatening hemorrhages or brain hemorrhages that affect neurological outcome, there was in fact no significant difference between the two groups. Despite this, long-term neurological outcomes were overall worse in the older group. For example, three months after stroke, fewer than 20% of the older patients were living at home; compared with 70% of the younger group.

Commentary:

This study supports the concept that age alone should not exclude a person from receiving TPA for acute ischemic stroke. The study should help neurologists feel more comfortable regarding the risk of intracranial hemorrhage with TPA use in this population, and may subsequently result in better stroke outcomes for this group of patients, if they are otherwise eligible to receive TPA. The study also, though, indicates that stroke is overall not tolerated well by the elderly. Either due to baseline neurological problems prior to the stroke, or complications arising from the stroke itself, the elderly have a higher chance of have a poor outcome three months after stroke than their younger counterparts.

Stroke Doc

Please Note

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This website will provide periodic updates about important stroke-related news. The site contains general information only and is not intended to replace a physician's advice. Please consult a physician to address your specific healthcare questions.